Pediatric Cardiac 2
5. When caring for a 3 year old with tetralogy of Fallot, he nurse expects to see fatigue and poor activity tolerance. This is caused by: A. poor muscle tone B. inadequate oxygenation of tissues. C. restricted blood flow leaving the heart D. inadequate intake of food.
5. Correct: B The child's fatigue results from left to right shunting that occurs with tetralogy of Fallot. This shunting causes poorly oxygenated blood to circulate through the body. Poor muscle tone and inadequate food intake can result from this condition, but these are effects, not causes. Restricted blood flow leaving the heart is associated with aortic stenosis.
6. What congenital heart defect causes cyanosis in children? A. Atrial septal defect B. Coarctation of the aorta C. ventricular septal defect D. Trasposition of the great vessels
6. Correct Answer: D With transposition of the great vessels, the pulmonary artery is attached to the left ventricle and the aorta is attached to the right ventricle. The child is cyanotic because blood reaches the tissues from the right ventricle before being oxygenated by the lungs. In atrial septal defect and ventricular septal defect, blood is shunted from the left side of the heart to the right side through patent openings. Because the blood travels from left to right, it's oxygenated and doesn't produce cyanosis. Coarctation of the aorta is a narrowing of the aorta that decreases the circulation of oxygenated blood to the body. With this condition, the child won't be cyanotic unless cardiac output drops.
7. The nurse is aware that a common physiologic adaptation of children with tetralogy of Fallot is: A. Clubbing of fingers B. Slow, irregular respirations C. Subcutaneous hemorrhages D. Decreased red blood cell count
7. Correct Answer: A Hypoxia leads to poor peripheral circulation; clubbing occurs as a result of additional capillary development and tissue hypertrophy of the fingertips.
9. The mother of a child with a congenital cardiac defect asks the nurse why her child squats after exertion. The nurse should reply that this position: A. Reduces muscle aches B. Increases cardiac efficiency C. Enhances the pull of gravity D. Decreases blood volume in the extremities
9. Correct: B When the child squats, blood pools in the lower extremities because of flexion of the hips and knees; less blood returns to the hear, enabling the heart to beat more effectively.
Normal K+ levels are the same for newborns and older children/adults True or False
False Newborn K+ 3-6 mEq/L Older: 3.5-5.0 mEq/L
Breathing stimulates the closure of the Ductus arteriosis.
True
The clamping of the umbilical cord closes the Foramen Ovale. True or False
True
In the developing fetus, the ductus arteriosus (DA), is a shunt connecting the pulmonary artery to the aortic arch. True or False
True It allows most of the blood from the right ventricle to bypass the fetus' fluid-filled lungs, protecting the lungs from being overworked and allowing the right ventricle to strengthen.
Serum Digoxin levels are 0.8-2.9 ug/L True or False
True Serum Digoxin levels are 0.8-2.9 ug/L
1. Which of the following are correct statements regarding Digoxin (Lanoxin)? Check all that apply. A. Digoxin is the drug of choice to improve myocardial contractility B. Often prescribed to increase contractility and decrease afterload C. ALWAYS check dose with another Registered Nurse before administration D. Administration is normally IV for infants
1. A, B, C, Administration: Direct to the side of the mouth and rinse with water.
10. An infant with tetralogy of Fallot becomes cyanotic and dyspneic after a crying episode. To relieve the cyanosis and dyspnea, the nurse should place the infant in the: A. Orthopneic position B. Knee-chest position C. Lateral Sims' position D. Semi-Fowler's position
10. Correct: B Flexing the hips and knees decreases venous return to the heart from the legs; when venous return to the heart is decreased, the cardiac workload is decreased.
11. An appropriate nursing action to include in the care of an infant with congenital heart disease who has been admitted with heart failure is: A. Positioning flat on the back B. Encouraging nutritional fluids C. Offering small frequent feedings D. Measuring the head circumference
11. Correct: C Because these infants become extremely fatigued while sucking, small frequent feedings with adequate rest periods can improve their total intake.
12. An 8 year old is admitted with myocarditis and associated tachycardia, and is prescribed fuosemide (Lasix). Which lab value does the nurse need to closely monitor for this child? A. Calcium B. Glucose C. Potassium D. sodium
12. Correct: C
13. A one month old infant is admitted for confirmation of the diagnosis of ventricular septal defect. During the initial admission assessment, the nurse would expect to find: A. Bradycardia at rest B. Bounding peripheral pulses C. an activity related cyanosis D. a murmur at the left sternal border.
13. Correct: D This murmur is the most characteristic finding in children with VSD
14. A nurse is teaching the parents of a child with tetralogy of Fallot about hypercyanotic spells ("tet spells"). When a spell occurs, the parents should: A. call the physician immediately call the physician immediately B. use a calm, comforting approach C. lay the child in the supine position D. take the child to the nearest emergency dept.
14. Correct: B Hypercyanotic spells ("tet spells"), in which a child has an extreme bluish discoloration of the skin and mucous membranes, are commonly seen in children with tetralogy of Fallot (a condition with four cardiac anomalies: VSD, pulmonic stenosis, an overriding aorta, and right ventricular hypertrophy). The parents should maintain a calm, comforting approach and place the child in the knee-chest position. It isn't necessary to call the physician, and the spells aren't considered a medical emergency unless profound hypoxia occurs.
15. A nurse is teaching the mother of an infant who will take digoxin (Lanoxin) at home to treat a chronic tachyarrhythmia. Which signs of digoxin toxicity should the mother be taught? A. Blurred vision B. Heart rate of 180 beats/minute C. vomiting two or more feedings D. bulging of the anterior fontanel
15. Correct: C signs of digoxin toxicity include nausea, vomiting, blurred vision, and yellow-green visual spots, but the mother will only be able to assess objective symptoms such as vomiting. Digoxin causes a decreased heart rate, which can progress to complete heart block if toxicity occurs (digoxin toxicity doesn't lead to tachycardia). Bulging of the anterior fontanel is a sign of increased intracranial pressure.
16. A nurse is carting for a child who recently underwent a cardiac catheterization to diagnose a congenital heart defect. Which finding indicates the need for immediate action? A. Increased Pulse B. Decreased urine output C. Increased temperature D. Bleeding from the catheter site.
16. Correct: D Bleeding from the catheter site may become life threatening and demands immediate action. Immediately apply pressure to the site. An increased pulse indicates pain and the need for medication, which the nurse should give if other signs of pain are present, but it isn't an emergency intervention. Because a child must remain flat after a cardiac cath, a decrease in urine output may occur, but it doesn't require immediate action unless urine output is absent. An increased body temperature after cardiac catheterization is not abnormal.
17. A nurse is caring for a nine year old experiencing tachycardia due to myocarditis. Digoxin (lanoxin) is prescribed. Before giving digoxin to this child, the nurse should assess: A. apical pulse B. urine output C. radial pulse D. blood pressure
17. Correct: A digoxin slows the heart rate and strengthens contractions; it shouldn't be given if the heart rate is abnormally low with regard to the child's age. The most accurate measure of the child's heart rate is the apical (not radial) pulse. Urine output and blood pressure don't need to be assessed before digoxin administration.
18. A nurse is assessing a 5 year old with a history of heart failure. Which finding indicates that the child has adequate cardiac output? A. Urine output of 30 mL/h B. Heart rate of 120 beats/min C. Cap refill time of 10 to 15 sec D. bilateral crackles heard on auscultation.
18. Correct: A The minimal hourly urine output should be at least 30 mL/hr for an adult or a child. The normal heart rate for a 5 yr old is 70 to 90 bts minute. Adequate cap refill time is 3 to 5 seconds. Crackles are an abnormal finding and may indicate hypervolemia, or excess circulating fluid volume, and heart failure.
19. A nine year old received digoxin (Lanoxin) daily for the past 5 days of his hospitalization. Before giving him his dose this morning, the nurse performs a routine assessment. Which assessment finding indicates the need to hold the child's morning dose of digoxin? A. Vomiting B. palpitations C. increased heart rate D. Serum digoxin level of 1.2 ng/mL
19. Correct: A Vomiting is a sign of digoxin toxicity. Palpitations and increased heart rate indicate that digoxin is needed. The serum level is within the normal range.
2. Which nursing intervention best helps decrease anxiety for the parents of a child scheduled for cardiac surgery? A. Tell the parents not to worry, because the physician performs this procedure all the time. B. Obtain an order for anti-anxiety medication for the parents, if requested. C. Teach the parents and the child about the surgery 1 month before the procedure D. Explain the steps that will occur before and after surgery. The parents need something tangible to focus on.
2. Correct: D Telling the parents about the sequence of events before and after surgery will decrease their anxiety and increase cooperation. The nurse should listen to the parents' concerns, rather than dismissing them by telling them not to worry. It isn't appropriate to obtain an order for anti-anxiety medication for the parents. Children do best with preoperative teaching 3 to 7 days before a procedure rather than 1 month before.
20. A newborn is diagnosed with coarctation of the aorta. The infant is discharged with a prescription for digoxin (lanoxin) 0.05 mg PO every 12 hours. The bottle of digoxin is labeled 0.15 mg in 1/2 teaspoon, the nurse should teach the mother to administer the medication using a: A. Nipple B. Calibrated syringe C. Plastic measuring spoon D. Bottle with an ounce of water
20. Correct: B A calibrated syringe or dropper provides the most accurate measurement of the medication.
21. A complete blood workup is ordered for a 5 month old with tetralogy of Fallot. Because of the infant's heart disease, the nurse would expect the report to show: A. Anemia B. Polycythemia C. Agranulocytosis D. Thrombocytopenia
21. Correct: B The body responds to the chronic hypoxia caused by the heart defect by increasing the production of red blood cells in an attempt to increase the oxygen-carrying capacity of the blood.
22. A child underwent cardiac surgery and the nurse must prepare his parents for discharge. Which discharge instruction is correct? A. "Call your doctor before your child has dental care." B. "Keep your child away from other children for 6 months." C. "if your child vomits his digoxin, he may need a second dose". D. "Encourage the child to participate in activities so he can develop normally."
22. Correct: A Upon discharge, parents should be taught to call the physician before the child has dental care. The child may be at risk for bacterial endocarditis after surgery, and dental procedures are a common portal of entry for bacteria. The physician may order antibiotics before a dental procedure.
23. A child is suspected of having Kawasaki disease. Which finding is significant? A. Extreme lethargy B. Increased appetite C. Respiratory congestion D. Fever for at least 5 days
23. Correct: D Kawasaki disease is a type of vasculitis affecting small to medium sized vessels. It primarily affects the lymph nodes but may progress to the coronary arteries. A child with Kawasaki disease has afever for at least five days along with an erythematous rash, red tongue, and red, cracked dry lips. Irritability, not lethargy is seen in Kawasaki disease, along with decreased appetite and edema of the hands and feet. Respiratory congestion isn't a common symptom.
24. A child is in the pediatric intensive care unit immediately after cardiac surgery. Which nursing action is most important? A. Assess the airway. B. Administer sedation C. Maintain semi-Fowler's position. D. Monitor oxygen saturation readings.
24. Correct: A Child will return from surgery with ET tube and nurse should check for bilateral breath sounds to evaluate tube placement.
25. A 4-month old infant who has a congenital heart defect develops heart failure and is exhibiting marked dyspnea at rest . The nurse is aware this finding can be attributed to: A. anemia B. hypovolemia C. pulmonary edema D. metabolic acidosis
25. Correct: C The increased blood volume and pressure in the lungs resulting from left ventricular failure causes pulmonary edema; dyspnea, and early sign of failure, is probably caused by the decreased distensibility of the lungs.
26. A 3 month old infant is admitted with a diagnosis of tetralogy of Fallot. Assessment reveals that the infant's weight is in the 5th percentile. The nurse is aware that the reason for this inadequate weight gain is: A. Cyanosis leading to cerebral changes B. Decreased arterial Po2 resulting in polycythemia C. Activity intolerance resulting in deficient caloric intake D. Pulmonary hypertension resulting in recurrent respiratory infections.
26. Correct: C Because the infant tires so easily, sufficient calories cannot be infested to meet nutritional needs.
27. A 16 year old is admitted to the emergency department with complaints of sudden, severe chest pain. He says that he didn't experience any recent trauma to the chest. What should the nurse next ask about? A. Exercise and weight lifting B. Cocaine use C. Smoking D. Family history of myocardial infarction (MI)
27. Correct: B The nurse should next ask about cocaine use. Cocaine use can cause tachycardia, hypertension, coronary artery spasm with infarction, and pneumothorax resulting in severe, acute chest pain. Exercise, smoking, and family hx of MI can be addressed after the danger of cocaine-related complications has been eliminated.
28. A 12 year old is diagnosed with hypertension. The nurse understands that hypertension may lead to heart failure. Which assessment finding indicates that the child may have developed heart failure? A. Weight loss B. Bradycardia C. Sudden weight gain D. Bounding peripheral pulses
28. Correct: C Early signs of heart failure include tachycardia, sudden weight gain, scalp sweating, and weak peripheral pulses. Weight gain can indicate venous congestion. Tachycardia occurs with heart failure as the heart's workload increases. Weak peripheral pulses are a sign of heart failure.
29. A 1-year-old with postductal coarctation of the aorta is admitted to the acute care unit for treatment. When performing an assessment, the nurse finds that the lower extremities are cool. Which finding should the nurse anticipate as the assessment continues? A. Lethargy B. Low blood pressure in the arms C. Low blood pressure in the legs D. bilateral pedal edema
29. Correct: C Postductal coarctation of the aorta causes several changes in the lower extremities: diminished peripheral pulses, hypotension, and resulting cool temp. A child under age 3 can't describe his symptoms, but may exhibit exceptional irritability (rather than lethargy). High blood pressure in the upper portions of the body produces headache and vertigo. Pedal edema isn't related to diminished perfusion of the lower extremities.
3. Which medication is usually given to children diagnosed with Kawasaki disease? A. Acetaminophen (Tylenol) every 4 hours B. Amoxicillin (Amoxil) divided into three daily doses C. Aspirin daily D. Ibuprofen (Motrin) every 6 to 8 hours
3. Correct: C For kawasaki disease, aspirin is given initially in an anti-inflammatory dose to control fever and symptoms of inflammation. When fever has subsided, aspirin is continued at an antiplatelet dose. If the child develops coronary abnormalities, salicylate therapy is continued indefinitely. Acetaminophen and ibuprofen aren't used because they don't thin the blood. Amoxicillin is an antibiotic, and antibiotics aren't effective in treating kawasaki disease.
30. A 1 year old child is diagnosed with a congenital heart defect after cardiac catheterization. His parents express concern about activities at home. Which is the nurse's best response? A. "You'll have to establish strict discipline so that he learns what he can't do". B. "Allow him to play and be active as long as he doesn't get fatigued". C. "He'll only be able to play by himself." D. "Discipline and limit-setting need to be relaxed to reduce his stress and crying."
30. Correct: B Parents should encourage normalcy within the limits of the child's condition. The child needs to have appropriate limits and discipline, but being too strict or overindulging the child makes it hard for him to learn acceptable behavior. A 1 year old child is beginning to explore his world and needs to have activities with other children
4. When palpating the brachial, radial, and femoral pulses of a neonate, the nurse notes a difference in pulse amplitude between the femoral and radial pulses bilaterally. This difference suggests: A. patent ductus arteriosus B. coarctation of the aorta C. diminished cardiac output D. left to right shunting in the heart.
4. Correct: B A difference in pulse amplitude between the upper and lower extremities or between the femoral and radial pulses suggests a coarctation of the aorta (narrowing of the aorta below the left subclavian artery). A patent ductus arteriousus is associated with a bounding pulse due to left-to-right shunting of blood in the heart. A weak or thinner pulse indicates diminished cardiac output.
8. The nurse explains to the parents of a 5 year old with a VSD that a cardiac cath has been scheduled to: A. Identify the specific location of the defect B. Determine the degree of cardiomegaly present C. Confirm the presence of a pansystolic murmur D. Establish the presence of ventricular hypertrophy
8. Correct: A A cardiac catheterization will identify the exact location of the VSD as well as assess pulmonary pressures.